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Purpose: To evaluate the long-term effects of excimer laser treatment for ametropia after surgical treatment of rhegmatogenous retinal detachment (RRD) with scleral buckles. Setting: Helsinki University Eye Hospital, Helsinki, Finland. Methods: Ten patients (10 eyes) who had 1 or more surgeries for RRD followed by refractive surgery for myopia were retrospectively enrolled in this study and were examined after excimer laser refractive surgery. Photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) was performed using a Star S2 excimer laser system (Visx). The best spectacle-corrected visual acuity (BSCVA), refraction, degree of anisometropia, and topographical changes were evaluated before and after the surgeries. Results: All patients were free of asthenopic symptoms after refractive surgery. At the end of the follow-up, a mean of 67 months ± 14 (SD) after refractive surgery, 6 patients were within ±1.0 diopter of the intended correction. Compared with previously reported cohorts of myopic patients, the achieved refraction in patients who previously had a scleral buckling procedure was worse. The postoperative refraction was stable, and corneal topography did not show induced scar formation, keratectasia, or irregular astigmatism. After refractive surgery, the BSCVA improved 1 Snellen line in 3 patients and 2 lines in 1 patient. One patient lost 1 Snellen line and another patient lost 2 lines. Four patients showed no changes. New retinal complications were not observed. Conclusions: In the long-term, PRK and LASIK were safe methods for the treatment of myopia in RRD patients after scleral buckling. The predictability of myopic LASIK/PRK may be worse than generally reported in myopic cohorts. [Copyright &y& Elsevier]

Purpose: To examine the inflammatory reaction in acute or late-onset post-laser in situ keratomileusis (LASIK) diffuse lamellar keratitis (DLK) associated with an epithelial defect.Setting: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.Methods: Six consecutive LASIK patients presented with stage 2 to 3 unilateral DLK 1 to 4 days after formation of an epithelial detachment (intraoperatively or up to 19 months postoperatively). Five corneas of 5 DLK patients, 1 eye twice, were examined by corneal in vivo confocal microscopy 1 to 8 days after the appearance of the epithelial defect. Confocal microscopy of conjunctival venules was performed in 2 of 6 DLK patients to quantify leukocyte rolling and extravasation. Corneas of 5 patients and conjunctival venules of 4 patients who had uneventful LASIK served as controls.Results: Two of the 4 patients examined 0 to 1 day after the onset of DLK presented with small objects, presumably inflammatory cells (diameter 6.0 to 10.0 μm), in the LASIK flap interface. A third patient examined 1 day after the onset of DLK had larger objects (approximately 13.0 μm in diameter) in the interface. Three other cases (1 to 7 days after the onset of DLK) showed changes typical of keratocyte activation and altered extracellular matrix. All cases healed completely following treatment with steroids. Control LASIK subjects showed some keratocyte activation on day 5.Conclusions: Neither uneventful LASIK nor DLK induced an inflammatory reaction displaying leukocyte rolling in conjunctival venules or extravasation into the conjunctival stroma. Diffuse lamellar keratitis related to an epithelial defect does not always lead to the appearance of inflammatory cells in the flap interface. The corneal manifestations of epithelial defect-related DLK may originate from sterile epithelial–stromal or inflammatory cell–stromal cell interactions, leading to alteration of the keratocyte phenotype. [Copyright &y& Elsevier]

Purpose: To study the effect of photorefractive keratectomy (PRK) on the concentration of group IIA phospholipase A2 (GIIAPLA2) in tears.Setting: Departments of Ophthalmology and Pathology, University of Turku, Turku, and Helsinki University Eye Hospital, Helsinki, Finland.Methods: Tear samples were collected from 25 eyes of 23 patients (mean age 32.3 years ± 8.6 [SD]) preoperatively and 2 and 7 days after PRK. The GIIAPLA2 concentration in the tears was measured by time-resolved fluoroimmunoassay.Results: The GIIAPLA2 concentration was significantly lower and the tear fluid flow rate significantly higher 2 days after PRK than preoperatively. At 7 days, the GIIAPLA2 concentration and the tear fluid flow-corrected excretion of GIIAPLA2 were significantly higher than preoperatively and at 2 days. The tear flow rate was also significantly higher than preoperatively.Conclusions: The GIIAPLA2 content in tears decreased 2 days after PRK due to dilution of the GIIAPLA2 content during hypersecretion of reflex tears. Photorefractive keratectomy caused an increase in the tear flow rate, GIIAPLA2 concentration, and tear fluid flow-corrected excretion of GIIAPLA2 in tears 7 days after surgery, enhancing the protection of tears against bacterial infections. [Copyright &y& Elsevier]